DESCRIPTION: Verbatim from the Applicant?s Abstract In nursing homes, the average resident uses six different medications and 20 percent use at least 10 different medications. Given the medical complexity of nursing home residents, the use of multiple medications may be clinically appropriate. Yet, changes in pharmacokinetics and pharmacodynamics make older persons more vulnerable to adverse medication effects, placing them at increased risk for adverse drug events (ADEs). Gurwitz et al deemed 1.39 ADEs per 100 resident months as fatal, life-threatening, or serious. Of preventable ADEs, 70 percent occurred at the monitoring stage of the medication use process. Indeed, "...patients may be experiencing unnecessary adverse medication reactions as a result of inadequate monitoring of medications" (OIG, 1997). Few patient safety systems use information technology in the monitoring stage. Our application is unique in that we aim to test information technology designed specifically to alert prescribers and nursing facility staff to information that can reduce the threat to patient safety associated with ADEs using a unique clinical tool for health professionals (Geriatric Risk Assessment MDS Med Guide (GRAM)). The GRAM software is intended to assist in the decision-making process of evaluating complex medication regimens of older patients; facilitate incorporation of patient assessment data in the monitoring of medication therapy; and foster inclusion of recommendations in the care plan to prevent avoidable medication-related problems. We propose a large-scale randomized trial. We will recruit 26 nursing homes; half will receive the intervention. Evaluation of the project relies on existing data sources to trigger in-depth chart reviews. We will determine the extent to which the use of the GRAM clinical tool increases the incorporation of monitoring recommendations to detect ADEs into the resident care plan; reduces the incidence of delirium, falls with and without fracture, (the two most common ADEs in LTC) and hospitalizations due to ADEs; reduces the triggering of resident assessment protocol (RAPS) triggers for delirium and falls. We will also quantify the impact of the GRAM software on the efficiency, productivity, workload, and job satisfaction of the consultant pharmacists and nursing facility staff.